2011-02-24_REPORT - M2010002

• Permit No: M2010002
• IBM Index Class Name: REPORT
• Doc Date: 2/24/2011
• Doc Name: Annual Fee/Report/Map
• From: Wagner Rock LLC
• To: DRSM
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

-'I, .-.
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
- -reclamation-accomplished to-date-and during the-preceding year, new disturbances-that-are-anticipated-to occur- -
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year,-if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous vear's map are necessarv. then no new map is reauired, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
#q F- *- W
ANWAL FEE and REPORT RE UEST
R ?CEIV
?Wagner Rock LLC c/
M-2010-002 FEB 2 4 2011
lamation,
Wagner Pit Di ti on S of f` and ? s y
February 16, 2011
$323.00 (Due on or before your anniversary date)
Moffat
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Jay L. Wagner
-Att A.
Permittee Name:
Address:
Phone Number:
Fax Number:
Wagner Rock LLC
96400 E Hwy 40
Craig, CO 81625
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions a e enclosed.
7e;-o* S7,4g, '7
14
gnature of rporate Officer, Owner, or Designee 'A_ '/?
???„_ /
Date ?AA